Pyoderma Gangrenosum Masquerading as Wound Infection in the Early Postoperative

Period After Lumbar Spine Deformity Correction Surgery

 

Bryce S. Owen, Mark A. Pacult, Bryan S. Lee

 

Pyoderma gangrenosum (PG) is a rare immunologic phenomenon that mimics a surgical site infection (SSI). PG typically manifests as painful skin pustules that can rapidly progress to large necrotic ulcers with raised violaceous borders [1]. Because skin conditions caused by PG may appear to be necrotic, PG is often misdiagnosed as an SSI, which can lead to delays in definitive treatment, unnecessary procedures, and significantly increased healthcare costs [2]. The pathogenesis of PG, which occurs in tandem with other autoinflammatory diseases, is thought to be due to the dysfunctional activation of neutrophils and aberrant T cell activation and cytokine stimulation [3-5]. This hypersensitivity reaction may be triggered by skin trauma, which is a phenomenon known as pathergy, and it occurs in less than 1% of patients with PG [6-8]. Postoperative PG is most commonly described after surgery involving the abdomen or breast [9-14]. Only three studies note PG appearing in the postoperative setting after spine surgery … read more